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In fact, more than half of 631 physicians surveyed were unable to correctly diagnose diseases most likely to be wielded by bioterrorists.
"We wanted to see if physicians could identify the clues that were provided, so that they could make the proper diagnosis," said lead researcher Dr. Stephen Sisson, an assistant professor of medicine at Johns Hopkins University.
"For example, we found that physicians really don't do a good job being able to distinguish the clinical markers of the rash for chickenpox and smallpox," Sisson said. "They also had problems with distinguishing a patient's presenting with an attack of botulism from other illnesses."
Doctors did a better job identifying anthrax, Sisson said. "We think that's because the clinical marker, specifically the widening of the chest, is something we have all been attuned to since the anthrax attack of 2001."
The survey findings appear in the Sept. 26 issue of the Archives of Internal Medicine.
In their study, Sisson and his colleagues tested 631 physicians at 30 internal medicine residency programs in 16 states and Washington, D.C., between July 1, 2003, and June 10, 2004. The doctors were asked to recognize and treat bioterrorism-related diseases before and after taking an online course in bioterrorism disease.
Before the online review, 50.7 percent of the doctors correctly identified smallpox, 70.5 percent identified anthrax, 49.6 percent identified botulism, and 16.3 percent correctly identified plague. The overall average was 46.8 percent for correctly identifying all the diseases.
After the online review, the correct diagnosis averaged 79 percent, the researchers reported.
In addition, before the review, 14.6 percent of the doctors treated smallpox correctly, 17 percent treated anthrax correctly, 60.2 percent treated botulism correctly, and 9.7 percent treated plague correctly. The overall average for correctly treating a condition was 25.4 percent.
After the review, correct management averaged 79.1 percent, the researchers said.
"Physicians should familiarize themselves with certain clinical clues," Sisson said. "We are going to be part of the early warning system should there be a bioterrorism attack. In the event of an attack, isolation and quarantine are going to be the only chance we have."
One expert doesn't think all doctors need to be able to diagnose and treat specific diseases of bioterrorism, but they must know when to alert public health officials.
"I am not surprised clinicians have problems distinguishing one condition from another," said Dr. Luciana Borio, a senior fellow at the University of Pittsburgh's Center for Biosecurity. "It's very hard, especially if you don't see it every day."
Public health agencies are available to diagnose and make recommendations about these conditions, Borio said. "There is no reason on earth that physicians need to know the management of plague," she added.
What is important, according to Borio, is not the ability to recognize a specific condition, but to recognize that it is abnormal and to report it to public health officials. "The biggest enemy is complacency," she said. "But you see that in regular medicine."
But another expert thinks it is important for all doctors to diagnose and treat seldom seen diseases.
"Almost by definition, agents useful in bioterrorism are exotic," said Dr. David L. Katz, an associate professor of public health at Yale University School of Medicine. "That means they are seldom seen by physicians in practice. Whereas familiarity breeds competency, we are often much less adept at responding to the unfamiliar health threat."
"Preparing health-care providers to deal competently with threats they will see rarely, and perhaps never, is challenging," Katz said. "But it is a challenge that must be met in a post 9/11 world."
More information
The U.S. Centers for Disease Control and Prevention can tell you more about bioterrorism.
And, with the exception of obesity, curing any one disease won't save Medicare money, a new report finds.
"As we strive for the magic bullet or infinite life expectancy, we need to understand that health-care costs will go up in order to achieve this, and they will not go down," said Dr. Mark Fendrick, professor of internal medicine and health management and policy at the University of Michigan School of Medicine.
Added Dana Goldman, corporate chair and director of health economics at Rand Corp. in Santa Monica, Calif.: "If just a few of the promised technologies come on line, then Medicare and the entire society could face substantially increased health-care spending. We need to worry not only about the demographic risk [posed by the aging of the baby boomers], but also the risk of developing new technologies that appear to break the bank."
Goldman was lead author of a series of articles detailing the potential cost of new technologies that appears Monday in a Health Affairs Web exclusive.
The number of Americans aged 65 and over is projected to double by 2030. At the same time, scientists are actively engaged in finding panaceas for a range of ills that ail us.
As currently projected, Medicare spending will soar from 2.6 percent of the gross domestic product today to 9.2 percent in 2050. Medicare, the federal government's health-care plan for the elderly and disabled, is already the single largest source of health-care spending in the United States, the study authors reported.
Goldman led a team charged with seeing how changes in medical technology, disease and disability would affect future health spending for the elderly.
To do this, the researchers developed the Future Elderly Model (FEM), using a representative sample of about 100,000 elderly Medicare beneficiaries, to help predict future costs and the health status of the elderly.
The lead article focuses on how 10 technological advances in cardiovascular disease, neurological disease and cancer and the biology of aging would affect lifespan and spending in the period from 2002 to 2030.
If half of elderly patients with new cases of heart failure or heart attack were to receive implantable cardioverter defibrillators (ICDs), for instance, total treatment costs would rise to $27 billion in 2005 dollars.
Anti-aging technologies -- such as a drug to limit calorie intake, which some scientists believe could add years to the lives of even healthy people -- would increase health-care spending simply by increasing the number of people who live to become old.
Such a compound would increase spending allocated to health care by 14 percent in 2030, largely because it would result in 13 million more Medicare beneficiaries. The cost per additional year of life would work out to $11,000, a modest sum, according to the study authors.
If the compound only kept people alive in poor states of health, the cost per additional year of life would be $38,000, still a relatively modest amount.
One important question is who would use the technology. "How do we make sure that we get the technology in the hands of the patient for whom it's most valuable?" Goldman said. "The general story for all of these things is they get really expensive when you start doing them for large swaths of the patient population."
Another question is how to change incentives for developing the technologies in the first place. "In the automotive and consumer-electronics industries, there are incentives to develop good, cheap DVD players or good, cheap cars," Goldman said. "When it comes to medical technology, there is no incentive to develop something that's pretty good but less expensive because the people who are buying it don't pay for it. It's not surprising that everyone wants a Cadillac instead of a Hyundai."
A second article concluded that curing obesity -- by preventing weight gain in youth -- would save substantial amounts of taxpayers' money.
Currently, obesity accounts for at least $90 billion in direct health-care costs in the United States every year. Obese people will incur almost $40,000 in additional health-care costs over their lifetime.
Beginning at age 70, a person who is obese will cost Medicare about $149,000 over the remainder of his or her life, which is the highest level of any group covered by the insurance program. Medicare spending on an obese person is also 20 percent higher than for the next closest group -- the overweight -- and 35 percent higher than spending for people of normal weight.
What all this means, said Michael Chernew, professor of health management and policy at the University of Michigan School of Public Health, is that Americans need to prepare to spend more money and need to design health insurance products that make sure the new technologies are targeted to the right people.
"The challenge is to understand that not all medicine is life-saving medicine. We as a society need to think about how we want to limit access to things that we might perceive as discretionary," Chernew continued. "A lot of people don't have coverage for chiropractor care and we don't seem to think that is a disaster. It's crucial to give people essential care, but defining that is easier said than done."
More information
Visit the Medicare official site for more on this program.
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